Nitrogen gas embolism as a potential complication of cryosurgery for bone tumours

Nitrogen gas embolism as a potential complication of cryosurgery for bone tumours

Published: 08 Jan 2018

© Anaesthesia Cases / 2017-0244 / ISSN 2396-8397

Authors

Dr Prasanna Vani Vanamail [1]
Dr Kalpana Balakrishnan [2]
  • [1] Consultant, Anaesthesia, Cancer Institute, Adyar, Chennai, India
  • [2] Professor, Anaesthesia, Cancer Institute, Adyar, Chennai, India

Summary

Anaesthetic implications of cryosurgery for bone tumours have not been well described. We report a case of a patient undergoing cryosurgery with liquid nitrogen. Upon thawing to body temperature, liquid nitrogen can expand to produce a large volume of gas, predisposing to embolism. Our patient developed sudden oxygen desaturation and a fall in end-tidal carbon dioxide during fixation of the liquid nitrogen-treated bone, which was consistent with a diagnosis of venous gas embolism. Real-time end tidal nitrogen analysis and haemodynamic monitoring help in early detection. Management entails venting out the gas, delivering 100% oxygen and providing cardiovascular support. We conclude that nitrogen gas embolism is a potential complication during pedicle cryosurgery with liquid nitrogen.

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